1. Field of the Invention
This invention relates to the field of surgical devices. More specifically, this invention comprises an abrading device that is used for creating abrasions on a membrane, such as the pleural membrane.
2. Description of the Related Art
Pleurodesis is a medical procedure in which the pleural space, the space between the chest wall and the lung of a patient, is obliterated. This is commonly done in order to prevent the recurrence of pneumothorax or pleural effusion. Pleurodesis is accomplished by irritating the parietal pleura, thereby creating abrasions on the chest wall, which causes adhesion between the wall and the lung of a patient. Sealing off of the pleural space prevents unwanted fluid or air from entering and occupying the area after the surgery.
Pleurodesis is typically performed during a thoracotomy or a thoracoscopy. Both surgical techniques are used to enter the chest to perform any number of different medical procedures. The difference between the two techniques is related to the size of the incision that is made in the patient. The incision for a thoracotomy is made on the side of the patient's chest and is typically four to six inches long. In a thoracoscopic operation several small incisions, generally ¼ to 1 inch in diameter, are made in different places around the chest.
FIG. 2 shows a prior art thoracoport 32 with a thorascoscope 30 inserted through the thoracoport 32. Thoracoports 32, small tubes or pipe structures, are typically placed into the small incisions through the chest wall to allow for easy insertion of other small instruments, thereby reducing the risk of damage to surrounding tissues during insertion and withdrawal. A thoracoscope 30, or small fiber optical camera, is inserted through at least one of the thoracoports 32 to view the inside of the chest. This minimally invasive operation allows surgeons to have maximum mobility inside the chest without putting pressure on the ribs. It also allows a surgeon to enter and exit the chest with little trauma to the nerves that travel along the bottom edge of each rib. The benefits to patients include reduced post-operative pain, a faster recovery and less scarring.
Upon nearing the end of a thoracotomy or a thoracoscopy, a surgeon would typically perform surgical pleurodesis by irritating the pleural membrane with a rough pad. FIG. 1 illustrates the existing equipment used for this process. Surgeons attach prior art gauze 36 to a prior art Kelly clamp 34 and physically rub the rough pad along the pleural membrane. Kelly clamp 34 is a medical tool that resembles a pair of scissors; however, the blade is replaced by a locking clamp. A surgeon using a Kelly clamp 34 during a thoracotomy would typically have to disturb the incision site and surrounding tissue in order to push the abrasive gauze 36 into the patient's body between the chest wall and lung. This causes an increase in trauma to the surrounding tissue and likely extension of the initial incision site. Additionally, it is difficult to view the tissue that is being irritated, as the insertion of the Kelly clamp 34 blocks the surgeon's view.
Performing surgical pleurodesis at the end of a thoracoscopy is more difficult than in the thoracotomy. Because the incisions are small, a surgeon must stretch the incision site to fit the Kelly clamp 34 down into the pleural membrane. Again, the result is increased trauma, likely incision extension and difficulty in viewing the irritation process. Since the incision site is so small the reader will note that the insertion of the Kelly clamp 34 and rough gauze 36 is difficult and likely causes more trauma to the body than would be caused when working with a larger incision site.
Abrading devices have not previously been small enough to fit through a thoracoport or other small opening. Additionally, the abrading surface, usually a rough pad, has not previously been retractable into a smooth tube. A retractable abrading surface is particularly advantageous because a smooth and thin instrument can enter the patient's body through a thoracoport 32 or other small incision with little to no contact with “wound edges” and can be completely removed from the patient's chest without rubbing against the surrounding tissue. Furthermore, if the device is able to fit through a thoracoport 32, a thoracoscope 30 can be utilized to view the complete abrading process giving the surgeon extensive visibility to properly irritate the chest wall for complete adhesion.